Category Archives: Dental Insurance and Payment Solutions

Benefits of HMO Dental Insurance Plans

When to choose an HMO dental plan?

Having mentioned the numerous benefits of PPO over HMO dental plans, it may seem hard to imagine a scenario where an HMO plan is actually better. However that is not true. There are certain benefits of HMO plans which make them a great option for many individuals, such as:

Benefits of HMO dental plans include lower costs along with basic coverage

HMO dental plans almost always have lower monthly premiums and are less expensive than PPO plans. HMO plans cover your basic dental needs such as X-rays, exam and simple dental cleanings as well as a portion towards dental fillings and other basic dental needs. If you’re not anticipating having extensive dental treatment done, then an HMO dental plan may just be the right fit for you.

HMO dental plans offer discount fees for major treatment

For more expensive dental treatment, such as roots canals or crowns, your HMO plan will offer a discounted rate on treatment. This means that while you will probably have to pay more than if you had a PPO plan for treatment, but it’s still much less than if you were a cash patient.

To better illustrate this, we will serve an example of how HMO and PPO dental plans help pay towards major dental treatment. Lets assume you require a root canal, post and crown on your tooth. This is a very common dental treatment and falls under major dental treatment. Assume that your dentist fee is $800 for root canal and $1,000 for post and crown, totaling to $1,800 for the entire treatment. Here are the scenarios you will face in each case:

Patient paying cash

Cash patient, which means you don’t have any dental insurance, should expect to pay the entire $1,800 for a root canal, post and crown. Of course, you can possibly bargain them down to $1,600 or $1,700 if you were to pay cash instead of charge. But it’s unlikely that your dentist will go much lower than this under any circumstances.

Patient with a PPO plan

If you have a PPO plan, your fees will vary on what percentage is covered by your dental insurance. On average you can expect copays to run around $500 to $1,000 with most typical PPO plans. That means your insurance is covering more than half of the cost of your treatment, which is pretty good.

Patient with an HMO plan

HMO plans offer you a discounts on treatment. Of course this may be somewhat offset by upgrade fees which dentists who accept HMO plans typically incorporate. On average you can expect to have to pay between $1,000 to $1,500 for a root canal, post and crown if you have an HMO plan. As you can see, this is much higher copays than if you had a PPO plan. In fact it could actually end up being nearly the same as what a cash patient would have to pay for similar treatment!

HMO plans are great so long as you require little to no advanced dental treatment

An HMO dental plan should meet these basic needs If you have excellent teeth and gums. HMO dental plans cover X-rays as well as exams and simple cleanings. Even if you end up needing a cavity or two or forced to pay a copay for dental cleanings, it’s still much more economical to just pay these copays than the extra monthly premium. Don’t forget that your copays will essentially be offset by your reduced monthly premium.

Make sure that you’re certain that you don’t actually require more treatment than you initially presumed if planning on choosing an HMO dental plan. There are not a lot of benefits of HMO plan if you need lots of dental treatment. Keep in mind that things such as braces, wisdom teeth removal or crowns on unsuspecting teeth can be very expensive. If you need lots of dental treatment then a PPO dental plan is still your better option.

Finding a good HMO practice can be a bit challenging

Since most HMO dental plans provide poor reimbursements you may find it hard to find yourself a good dental office. You may end up with a dentist who ignores your necessary dental treatments. Conversely, you might find a good HMO dental provider, but notice that they constantly demand substantial out-of-pocket upgrade and copays.

It could be quite a challenge finding a good dentist nearby that accepts your HMO dental plan while also offering great services. Many HMO dental offices are corporate ran and you may have a different dentist or hygienist every time you go there. If you’re seeking an HMO provider, then do some research first to make sure the dental office is a reputable one. Also verify that your dentist is stable and has been there for a while and is also planning on sticking around for several more years. This is important just in case you require followup on your treatment.

NEXT >> Deciding between PPO or HMO dental plans

Benefits of PPO dental insurance plans

Deciding between PPO or HMO Dental Plans

10 Questions to help you decide between PPO or HMO dental plans

After reading the advantages of PPO and HMO plans, it’s now time to make a decision. Here is a list of question to better help you decide if you should choose a PPO or HMO dental plan. Please answer each question with either a “yes” or “no“:

  1. Are you expecting your dental treatment to include lots of work? Basically much more than just a simple cleaning or maybe a filling or two here and there.
  2. Do you anticipate the need for crowns or root canals in the near future?
  3. You’re suffering from a toothache right now or have been as of recently?
  4. Do you suffer from jaw (TMJ) problems, chronic bad breath, food getting trapped between teeth, or other similar dental related problems?
  5. Has it been a long time since you’ve gone to the dentist?
  6. You don’t have significant amount of existing dental work in your mouth already?
  7. Do you have advanced gum disease which requires constant treatment and frequent deep cleanings?
  8. Do you still have your wisdom teeth and you suspect that they might have to be removed?
  9. You don’t have any missing teeth in your mouth?
  10. There aren’t that many dentists in your neighborhood? For instance you live in a small town with only a handful of dentists available to you.

Good candidate for PPO dental plans

If you  answered “yes” to most of the above questions then you probably should probably consider selecting a PPO dental plan.

Questions 1 through 5: Anticipating dental work

If you need any sort of major dental treatment, such as root canals, crowns, bridges, etc. then selecting a PPO dental plan is most likely the better route to go. This is a good time to note that you should be cautious if you’re planning on receiving treatment such as dental implants, braces or cosmetic work. These treatments are often times not covered by neither PPO or HMO plans. So while having a good dental insurance can definitely help reduce your costs, expect to have substantial copays regardless of whether you have a PPO or HMO dental plan!

Dental implant coverage through dental insurance

A portion of your dental implant treatment may be covered by your PPO plan. However, the majority of dental insurances are still not covering dental implants. Many have a pre-exclusion clause which means that if you lost the tooth before you obtained this particular insurance then it would not be a covered benefit. Don’t forget that insurances require X-rays to verify this so you can’t get fool them either!

But even if your insurance does pay a portion, dental implant treatment will still require substantial out-of-pocket fees. Still, having a PPO plan could benefit you and reduce your costs by covering extractions and other related work. Also keep in mind that because of insurance maximum annual coverage, dental insurance is only helpful if you require one or two dental implants. If you’re expecting to receive a mouth full of dental implants, then you can’t rely on insurance and must pay for treatment yourself.

Orthodontic treatment coverage through dental insurance

Orthodontic treatment is typically only a covered benefit for children and young adults. Braces usually has an age cut off and adult braces is rarely covered. In addition to that, clear-braces is almost never a covered benefit. If you’re an adult who is planning on receiving orthodontic work, then inquire into what the age cut off is.

However, it might still be better to select a PPO plan if you’re planning on receiving braces. Your orthodontic treatment may require removing some teeth, restoring your teeth and possibly advanced gum cleanings so it’s always better to have good coverage just in case.

Cosmetic dentistry coverage through dental insurance

Cosmetic dentistry is never a covered benefit regardless of whether you have a PPO or HMO dental plan. Basically, you are going to have to pay out-of-pocket for teeth whitening or veneer treatments. Still, having a good insurance can come in handy. For instance, your dentist may be able to justify one or two ceramic white crowns as medically necessary in place of a few veneers and throw them in the mix. However don’t expect too much, as you will be on the hook for the majority of cosmetic treatment expenses.

Question 6: Existing dental work

If you already have a lot of existing dental work, then you need to always carry good dental insurance. If you’ve had a ton of fillings, crowns, bridges, etc. then you already know that things can always go wrong with them. And when they do, you almost always end up needing thousands of dollars in new dental treatment. Keeping a good dental insurance handy helps reduce your panic levels the next time one of your crown develops an infection or breaks off!

Question 7: Gum disease

If you have advanced gum disease, known as periodontitis, then you know the importance of regular dental cleanings. If you’ve been advised to get a dental cleaning every 3 to 4 months, then your gums require extra attention. Keeping a good dental insurance that allows for a few dental cleanings each year and covers deep cleanings can come in quite handy in these circumstances.

Question 8: Wisdom teeth

If you’ve already removed your wisdom teeth then you don’t need to worry about this. Also, if you’ve been advised correctly that you can keep your wisdom teeth, then you still don’t have to worry about this one. However, if you’ve had problems with your wisdom teeth in the past, then keeping a good dental insurance plan will definitely come in handy, just in case. In fact, it’s best to consider removing your wisdom teeth while you still have coverage to avoid future problems.

Question 9: Replacing missing teeth

If you have teeth missing then you need to have good dental insurance. Obviously you may require implants, bridges or dentures to close these gaps or replace failing existing ones. However, people with missing teeth are also much more likely to develop new dental problems than those with a full set of teeth. Gaps between your teeth can contribute to teeth shifting, food trapping, cavities, etc. which creates additional problems. As a result, it’s always best to keep a good dental insurance handy for when the next problem decides to occur.

Questions 10: Access to a dentist

If you live in a large metropolitan area like Boston, New York or Los Angeles, then there’s probably about 1,000 dental offices within a mile of where you live. You should be able to find a good dentist regardless of whether you have a PPO or HMO dental plan. However, if you live in a small village or town, access to dentists may be limited. If there’s only a handful of dentists around you, it might not be a bad idea to do some research and find out which dental plans they accept. It’s probably better to select a PPO plan in most cases as an HMO could mean driving a long distance or ending up with a dentist that you might not end up liking very much.

Good candidate for HMO dental plan

If you answered “no” to most of the above questions then an HMO dental plan is probably good enough. After all, if you require just two basic cleanings a year then why pay extra for something you won’t use? Even if you end up having to cover a small copay for dental cleanings or a filling or two here and there, it still makes more sense to stick with an HMO dental plan in these circumstances.

Final thought on choosing a PPO or HMO dental plan

The decision of choosing a PPO or HMO dental plan ultimately hinges on many factors including on how much treatment you require, how many dentists accept HMO plans in your neighborhood, what experience you’ve had in the past and other variables.

A PPO dental plan usually wins out because it basically provides you with better overall coverage, which is typically worth the additional monthly premium. Also, since more dentists accept these PPO plans, you’re more likely to end up in a nicer office with a dentist that you might actually like!

What to do if your dentist accepts both the PPO and HMO plan?

If your dentist accepts both PPO and HMO plans, then plan on starting off with PPO coverage. This allows you to fix necessary dental problems while reducing your out-of-pocket expenses. Once you have completed major treatments and begun maintenance phase, then you can consider switching to an HMO plan.

Keep in mind that this might take a while, so don’t be in a rush to switch too early either. Consider talking to your dentist beforehand to see if he or she recommends switching insurance plans. If you’re considered a high risk level patient then it’s not advisable to downgrade your insurance plan at any point. Discuss this with your dentist to see if this transition is suitable for you or not.

NEXT >> Benefits of PPO dental insurance plans

Benefits of HMO dental Insurance plans

Alternatives and Risks of Healthcare Financing

What are the risks of using healthcare financing for dental treatment?

Healthcare financing is a way to afford dental treatment when short on money. It is essentially a credit card that allows you to receive dental as well as other medical treatment and gradually pay it off. There are a few companies such as CareCredit, LendingTree, iCare Financial and SimplePay that offer healthcare financing. While being able to receive your treatment now and pay for it later sounds great, there are certain risks of healthcare financing which you should be aware of as well:

Getting denied for healthcare financing

Healthcare financing is not automatic and the better plans require a credit check. Not everyone who applies will get approved for healthcare financing. If your credit is poor, income is insufficient, or there are other issues then you may not get approved.

If you get rejected for healthcare financing then don’t get upset or panic. Consider reapplying for a lesser amount instead. If this works, then focus on using this lesser funds to address your most urgent needs. Should you get rejected for healthcare financing you may want to build up your credit in the future. If you continue to make your monthly payments on time then you might be able to increase your credit limit in the future. This way you might be able to finish the rest of your work sooner than you had expected.

Worrying about having to pay interests and penalties

If you’ve dealt with a credit card in the past then you have an idea of issues which come along with it. If you’re late with a single payment it costs you dearly. Risks of healthcare financing causing you to have to pay additional fees and high interest rates are always there if you’re not very careful.

If you end up being unable to make your payments as planned, then you are forced to extend your payments. This means you have to keep paying more and more in interest and penalties. Fines and penalties, phone calls and letters as well as damage to your credit will all ensure this. So if you’re not very good at making payments on time, then you must decide between your oral health and mental health!

Risks of healthcare financing stretching you out too thin

You need to make sure that financing dental work is a priority in your life. As you know, there are other things in life which we all need aside from our teeth. Housing, transportation, food or possibly even other unpredicted essential medical problems may come up. You must prioritize your needs to see if right now is a good time to fix your teeth and gums.

Additionally, be weary of applying for healthcare financing if you have a bug purchase coming up. Running your credit too many times can affect these big purchases, so be cautious if you’re about to close on a house or buy a new car. Pay cash or postpone treatment for a few weeks until you’ve sorted these issues out.

What are the alternatives to healthcare financing?

As mentioned earlier, there are certain risks of healthcare financing such as getting denied or being unable to make payments on time. Healthcare financing might not be for everyone. If financing doesn’t make a whole lot of sense to you, then consider these other alternatives to healthcare financing instead:

Address your chief complaint for the time being

If you can’t afford healthcare financing, then consider receiving only the most essential dental treatment for the time being. Pull that painful tooth, get your dental cleaning, or place a single crown on the one broken tooth. Then try to get dental insurance, save up some money or build up your credit and return soon to finish the rest of your work.

Make a payment plan with your dentist

Paying little by little as you go is another alternative to healthcare financing. Talk to your dentist to see if they allow you to come up with a payment plan directly with them instead of the healthcare financing company. Risks of healthcare financing with a bank is much higher than with your local neighborhood dentist. Your dentist will be much less inclined to ruin your credit or take you to court over a missed payment.

Keep in mind that direct payment plans only work if you come up with a reasonable way to stretch out your treatment along with your payments side-by-side. No dentist wants to finish your treatment while you still owe them thousands of dollars. For instance, if your treatment is $2500 then you can arrange five payments of $500 or ten payments of $250 to make it work for both you and your dentist.

If you don’t need too much work then you can fix your teeth one at a time

You may not be in as much rush to get all your treatment done. After all with around 28 teeth in a healthy adult’s mouth, how much worse can a single tooth get within a few more weeks or months? Of course we are making light of matters here, this is not the right attitude to have. Essential dental work only keeps piling up, becoming more complicated and costly as time passes. However you might be able to postpone your braces of a few of your less essential crowns for a bit longer.

A good compromise would be to prioritize your dental treatment. Start by addressing your most urgent needs first. Then work your way down the priority list as we previously described. Talk to your dentist about what your most urgent treatments are, what is important but can wait, and what’s optional and can be completed when all other work is done. This will give you a better understanding of how to best approach fixing your teeth and gums.

Once you’ve figured out the order in which you should receive your treatment, then make arrangement to come in and get your work done little by little. This way you can make small payments on each appointment. Say once a week, once every two weeks or one time a month, whatever works best for you. This way you can get your treatment done without having to worry about making mandatory monthly payments.

Elect a less expensive treatment instead

Electing to receive a less expensive alternative treatment option instead. You might just have to wear dentures for a while until you can afford your dental implants. Or you might have to stuck a filling on that large cracked tooth while you save up for the crown.

As a last resort, postpone treatment

Postponing your treatment altogether should be your last resort. Do so at your own risk with the full understanding of what your treatment needs are and what complications arise as a result of delaying treatment.

Should I use healthcare financing for cosmetic dental treatment?

Healthcare financing is very beneficial to rid yourself of pain or render essential dental treatment. If you have to use financing to get these treatment done then it makes sense to do so. Even things such as replacing a missing tooth with a bridge or a dental implant is important. Missing teeth cause your other teeth to collapse and make your bite become crooked over time. Using healthcare financing makes sense here as well.

On the other hand, if you want to place veneers or receive other cosmetic treatment to improve your looks then you should think long and hard about using healthcare financing. Risks of healthcare financing can end up costing you more than you think. Consider if getting veneers is something that is worth paying on for the next two or three years. Also, be sure that there are no other pressing medical needs before dedicating your healthcare financing to receiving cosmetic treatments. However, once all your other dental work is completed, if you really want that pretty white smile and can afford the payments then by all means go for it!

NEXT >> 10 Questions to help you with choosing healthcare financing for your dental treatment

What are the benefits of healthcare financing for dental treatment?